Richard_Hom said:
In each case, his condition never completely resolved. 3 nasolacrimal probes have been done over the past year with resolution only being about a month.
Probing is not enough with recurrent dacryocystitis. He needs referral to an ophthalmologist for a dacryocystorhinostomy.
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12045908
The pathogenesis and treatment of lacrimal obstruction: The value of lacrimal sac and bone analysis.
Orbit. 2001 Sep;20(3):163-172.
DeAngelis D, Hurwitz J, Oestreicher J, Howarth D.
Ophthalmic Plastic Surgery Service, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
INTRODUCTION. The cause of primary acquired nasolacrimal duct obstruction (NLDO) has not been fully elucidated. In an attempt to determine the role of an inflammatory etiology, the pathology of nasolacrimal sac and bone specimens was assessed and correlated with clinical lacrimal variables. MATERIALS AND METHODS. Lacrimal sac and bone tissues from patients with known NLDO were sampled at the time of external dacryocystorhinostomy (DCR). Histopathological analysis was carried out to determine the presence and degree of inflammatory changes present in the tissues, and to correlate them with the clinical presentation. RESULTS. Of 104 cases analyzed, bony inflammatory changes were seen in 14% and lacrimal sac inflammatory changes in 94%. All cases of bony inflammation had accompanying lacrimal sac inflammation. The inflammatory changes were independent of the following variables: gender, duration of symptoms, a history of dacryocystitis, the presence of a lacrimal sac mucocele, the location of obstruction, and the presence of lacrimal sac calculi. CONCLUSIONS. Inflammatory changes are almost invariably present in all patients with NLDO. Its occurrence in bone is probably secondary to lacrimal sac inflammation. Although attempts are made to perform DCR surgery only in the absence of lacrimal sac inflammation, almost all cases exhibit subclinical inflammation. This may suggest that bypassing this 'critical area' of the sac-duct junction, as in a dacryocystorhinostomy, would be more reasonable than to re-canalize through an inflammatory obstruction.
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12062223
Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases.
Jpn J Ophthalmol. 2002 Mar-Apr;46(2):177-82.
Kubo M, Sakuraba T, Arai Y, Nakazawa M.
Department of Ophthalmology, Hirosaki University School of Medicine, Hirosaki, Japan.
BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.
